of a client; for example, a sedative-hypnotic may be used to make bed rest less
frustrating. Sedative-hypnotics are sometimes used as muscle relaxants,
anticonvulsants, and even general anesthetics.
3-5.
SIDE EFFECTS
All of the sedative-hypnotics are capable of causing drowsiness, impaired
judgment, and loss of coordination. These effects correspond to those of alcohol
administered in amounts of comparable strength. In fact, alcohol and sedative-
hypnotics have an additive effect in the body. The use of sedative-hypnotics, especially
the long-acting ones, may be followed by a hangover, that is, a feeling of fatigue or
grogginess. As previously mentioned, a withdrawal state may occur when a client is
removed from a regimen of high doses given over an extended period. This withdrawal
state corresponds to delirium tremens in alcoholics. It includes such symptoms as
weakness, tremors, high blood pressure, fast breathing, fast pulse, and possibly
convulsions, confusion, and hallucinations. Thus, it is possible to become physically
dependent on sedative-hypnotics, as well as psychologically habituated to them.
Tolerance to a nightly hypnotic dose does not usually develop to the point where
increased doses are required. However, when these drugs are used continually as
sedatives, tolerance may develop rapidly.
3-6.
OVERDOSES OF SEDATIVE-HYPNOTICS
An intentional overdose of "sleeping pills" is frequently chosen as a means to
commit suicide. When an individual ingests as little as eight times the hypnotic dose of
a sedative-hypnotic, he may die of circulatory collapse or respiratory depression
(slowing or cessation of breathing). However, if a client who has received even a very
large overdose is given proper treatment soon after the overdose, he will probably not
die. The lethal doses of the less potent sedative- hypnotics are so large that successful
suicides are rare. The risk of death is greater if the person is under the influence of
additional CNS depressants, such as alcohol.
3-7.
SUMMARY OF INDIVIDUAL AGENTS
The use of barbiturates, a group of chemically related organic compounds, as
sedative-hypnotics, began in 1903 with the introduction of barbital (Veronal). This was
followed in 1912 by the introduction of phenobarbital (Luminal), still one of the most
widely used CNS depressants. Today, out of about 50 barbiturates sold for clinical use,
only about a dozen are widely used and a selected group of 5 or 6 is sufficient to meet
the requirements of most prescribers. In addition, there are a number of nonbarbiturate
sedative-hypnotics. These include the time-proven chloral hydrate and several newer
drugs. (The nonbarbiturates discussed below are distinguishable from the barbiturates
because the names of the barbiturates end with "-al.")
MD0913
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